President's Malaria Initiative and Angola Part 2

Below is a comment, on the PMI clarification, from one of the authors of the WHO Bulletin article.

In regard to the Director’s response to criticisms about the PMI program in Angola, I would like to make a few comments, having written the article in English, with the approval of my two colleagues, especially Martinho Somandjinga, the first author and an experienced and highly competent malaria control official.

The primary fault in the whole story was the use of administrative reports on malaria, based on clinical diagnoses of malaria, which in fact were simply diagnoses of fever and headache.  No blood slides were taken to confirm these administrative reports.  Therein lies the problem.

The secondary problem we pointed out is that WHO, in their global planning and analysis, uses the same faulty administrative reports of fevers, instead of making lab diagnoses for the malaria parasite.

Thirdly, although Mr. Somandjinga and I worked out and recommended to PMI a monitoring plan complete with labs, blood slide collections, and microscopic diagnoses, PMI has continued to ignore the need for this more precise process for monitoring and evaluating their effort in Angola and in the rest of Africa.

The First Law for attacking malaria in Africa is that it is like building a huge cathedral or mosque, it will take generations.  So evaluation and monitoring is essential if we are to make progress over the next several decades.  You cannot control malaria in Africa with public relations, it is a tough disease.

A really good sign however, is the increased role of epidemiologists from CDC in PMI and in Geneva.  These folks know the score.  Some have run studies showing that the false positivity rate of these clinical diagnoses is erratic and can be very high, like 50%!  And a recent study in Khartoum showed a false positive rate of 90%.  So the administrative data is useless, and I trust Robert Newman and Larry Slutsker will work towards establishment of microscopic diagnoses on appropriate sentinel populations.  Then we will know what the problem really is, and where to put our efforts.

It will take a while, but we can do it.  And now is a wonderful time to capture the popular enthusiasm for malaria control in Africa.

Bill Jobin
Cortez, Colorado


3 Responses to “President's Malaria Initiative and Angola Part 2”

  1. 1 Pavak February 3, 2010 at 11:20 am

    Engineers and statisticians typically call this GIGO: Garbage In, Garbage Out. Policy and intervention based on deeply flawed data is itself likely to be just as deeply flawed. I wonder if a DOTS-like strategy needs to be considered for malaria.

  2. 2 Alejandro Mesiti April 12, 2010 at 7:05 pm

    Heya I’m attempting to sign up for your rss , but it’s not working . What is happening ?

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